Emergency airway puncture

Emergency airway puncture is done in an emergency situation, when someone is choking and all other efforts to assist with breathing have failed.

• A hollow needle or tube can be inserted into the throat, just below the Adam's apple (thyroid cartilage), into the airway. The needle passes through the skin then between the thyroid cartilage and the cricoid cartilage.
• In a hospital, before inserting the needle, a small cut may be made in the skin and the membrane between the thyroid and cricoid cartilages.

A needle cricothyrotomy is an emergency procedure to relieve an airway obstruction until surgery can be done to place a breathing tube (tracheostomy or surgical cricothyrotomy).

If the airway blockage occurs with trauma to the head, neck, or spine, care must be taken to avoid further injury to the person.

Risks for this procedure include:

• Injury to the voice box (larynx), thyroid gland, or esophagus

Risks for any surgery are:

• Bleeding
• Infection

How well the person does depends on the cause of the airway blockage and how quickly the person receives proper breathing support. Emergency airway puncture provides enough breathing support for only a very short period of time.

Needle cricothyrotomy

Cavallone LF, Cattano D, Piacentini AGG. Percutaneous emergency airway access. In: Hagberg C, ed. Hagberg and Benumof's Airway Management. 5th ed. Philadelphia, PA: Elsevier; 2023:chap 28.

Hebert RB, Thomas D. Cricothyrotomy and percutaneous translaryngeal ventilation. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 6.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.